David Cameron’s unhealthy NHS fight

LONDON — David Cameron is discovering the deeper truth behind a former Conservative chancellor’s quip that the National Health Service “is the closest thing the English have to a religion.”

After taking an ax to the NHS over several years, from privatizing services to restructuring and job cuts, the prime minister may have finally hit a brick wall: the service’s respected work-horses, junior doctors, who have agreed to go on strike starting with one day next week.

The resistance to the government’s proposal to overhaul their contract and phase out automatic pay shouldn’t come as a surprise. Throughout its nearly 70-year history, politicians trying to tamper with the country’s socialized medicine scheme have faced an uphill fight.

“From the beginning it has been seen as something that is astonishingly equaling; to create a physical level playing field independent of class,” said Roberta Bivins, of Warwick University’s Centre for the History of Medicine.

Cameron’s Conservatives are hitting up against a highly organized opposition able to draw on a deep well of public backing.

A ComRes poll before the 2015 general election found 57 percent would pay higher taxes to further support the NHS. More recently, a poll of nearly 30,000 people by the Guardian showed 95 percent backed the junior doctors’ strike.

Cameron and his party say their changes are intended to improve patient care. Health Secretary Jeremy Hunt told the Commons that there remains one item out of 16 in the doctors’ contract left to agree, that of weekend pay.

While both sides agreed to continue negotiating, the doctors’ rep walked out after one hour of talks to announce strikes on Monday, signaling their frustration.

Embedded in national culture

Reverence for the NHS is rooted in the creation story of the behemoth organization — the fifth largest employer in the world — and the extent to which it transformed British culture and identity.

On July 5, 1948, the health service became “national” under the Labour party, when Health Secretary Aneurin Bevan opened Park Hospital in Manchester. Ill health, its backers claimed, was no longer something poor people feared.

Various governments, both left and right, have tried to tinker with the NHS — usually with mixed success.

The final day of three proposed strike periods, starting next week, would be a complete walkout by nearly 37,000 junior doctors, of around 50,000 total in England, of all health services, including emergency care.

This would be the first ever doctors’ strike of emergency care, leaving senior consultants, nurses and doctors not unaffiliated to the union to cover for them.

Britain’s Prime Minister David Cameron speaks to a nurse as matron Sandra Allen (R) listens during a visit to Whitney Community Hospital on April 11, 2015

The British Medical Association, negotiating for the doctors, is a force to be reckoned with. The former Health Secretary Andrew Lansley was sacked by Cameron in September 2014 — two months after the BMA called for his demise over a larger set of reforms of the NHS that proposed thousands of job cuts, which health professionals also protested.

Those changes, which were adopted, took out thousands of middle-managers, cut nursing numbers and made doctors, as opposed to managers, more responsible for purchasing services.

Although the doctors have broad public support, there is some criticism of their tactics. Roger Goss, co-director of Patient Concern, a patient advocacy group, said he would give the government the benefit of the doubt that the contract changes are meant to improve patient safety.

“We cannot figure out if the BMA’s claim that the contract changes will result in longer hours or longer shifts for individual doctors is true, and are therefore potentially unsafe. We do not see why this should be so if the Department of Health has done its job properly,” he said.

Conservative roots

Despite being a massive government program and its formal introduction by the Labour party, the idea for the NHS has conservative origins.

It was the so-called Beveridge Report in 1942 — the Social Insurance and Allied Services report, chaired by the Liberal economist William Beveridge — that proposed it. Beveridge is now a term used to describe similar health systems around the world, from Spain to most of Scandinavia.

Under the leadership of Conservative Winston Churchill and his wartime coalition, there was cross-party consensus on social policy. During the 1945 general election, the parties’ full support for the Beveridge Report was reflected in their common pledges to each form a National Health Service, albeit with varying commitments.

Approaching the 70th anniversary of the NHS, the original support from across the political spectrum is the backdrop to debates over the service’s future.

Still, every general election, the country hears the same rhetoric from the left: “Labour made the NHS, Tories try to stop it.”

“Both parties try to claim that they founded it; Labour was more effective but both parties try to claim it, and both parties claim the other is trying the threaten it,” Bivins said.

In the weeks before the May 2015 general election, an Ipsos Mori poll showed the NHS was the second most important issue to voters, a close second to immigration.

In the current fight, Cameron has been at pains to frame the changes as a focus on “patients,” not as an attack on the system. On BBC Radio 4’s Today program Tuesday, Hunt said: “Pay is one of the issues and another is safety.”

He underlined that the government was increasing the NHS budget by £3.8 billion in real terms next year, and doctors’ pay package would not fall.
The doctors say that despite a raise to base pay, the changes to hours and weekend work mean they will get less and work more.

And Labour is pushing the line that the NHS is under threat.

Historically, public support for nurses has swelled at times of strike, but not so much for consultants, more senior doctors who are already seen as overpaid. Junior doctors sit in the middle.

Now Hunt, a former management consultant who still owns a stake in a PR firm he co-founded, is walking a knife’s edge with the junior doctors’ contract. If he fails to negotiate terms to avoid the strikes, it will go down on his watch. Like Lansley before him, this could be political suicide for Hunt, given the strength of support for the NHS and junior doctors.

Other right-wing leaders have been more willing to criticize the doctors.

U.K. Independence Party’s Nigel Farage told LBC that he thought junior doctors were being “extremely militant,” and had little sympathy.
Labour leader Jeremy Corbyn has remained silent, though he was busying reshuffling his cabinet this week.

‘Privatizing’ the NHS

Since the 1980s, auxiliary services such as cleaning have been outsourced. Tony Blair’s Labour government introduced public-private hospital partnerships. Most recently, Cameron’s new Health and Social Care Act (pushed through under the former Conservative-Liberal Democrat coalition) allows up to 49 percent of NHS services to be outsourced to private companies, but still paid for out of the public purse.

Alan Taman, campaigns and media officer at campaign group Keep Our NHS Public, said that “neoliberal ideals” are fundamentally at odds with the NHS, calling Cameron’s changes “the culmination of 20-plus years of legal undoing.”

It is “an act of abandonment and sacrifice of the public good to neoliberal ideals based on nothing more than dogmatic assertion of dubious values, which our great-grandchildren will curse us for unless we stop that process this really represents — the dismantling of the NHS for privatization,” he said.

Others say such claims about the privatization of the NHS are exaggerated. According to health policy think tank The Kings Fund, around 10 percent of NHS services are provided by the private sector.

Its review of policy reforms during the 2010-15 coalition government, led by Cameron, concluded that the upheaval caused by the Health and Social Care Act has been “damaging and distracting.”

“Only [lately] has the government adopted a more positive focus on improving patient care and achieving closer integration of services,” Chris Ham, report author and CEO of the think tank, said. “Politicians should be wary of ever again embarking on such a sweeping and complicated reorganization of the NHS,” he cautioned in the report.

Regardless of the outcome of the contract fight, patients’ care will remain free at the point of use: day, night and at weekends, as it always has been. And doctors will probably continue to grumble about pay.

By the end of Wednesday, both sides publicly agreed negotiations should continue. Acas, the mediator, told POLITICO discussions will resume on Friday.